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NPI Code Detail

MEDICARE: ANDREA SIMMONS RDN

MEDICARE: ANDREA SIMMONS RDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian5606TN
2133V00000XRegistered DietitianD-2911MS

General Provider Information

NPI Number : 1093674590
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA SIMMONS RDN
Provider Business Mailing Address
First Line : 6263 POPLAR AVE STE 605
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-4724
Country : US
Telephone Number : 901-343-6146
Fax Number : 901-328-1802
Provider Business Practice Location Address
First Line : 6263 POPLAR AVE STE 605
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-4724
Country : US
Telephone Number : 901-343-6146
Fax Number : 901-328-1802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2026
Last Update Date : 05/07/2026

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